TWIDH - Diabetes Management with Cyndi Williams of Quin
Quin: The diabetes app for smarter insulin management decisions allows you to access highly personalized sets of curated data, step-by-step learning adapted to your needs, and tools to help you plan with more confidence and support Type 1 Diabetes patients.
(edited for publication)
Good afternoon. Welcome to another edition of This Week in Digital Health. We're here today with Cyndi Williams of Quin. They are a startup that has developed an AI-driven app that helps people with diabetes better manage their care. So Cindy, welcome. And thank you for joining us today.
Thank you. It's good to be here.
How long ago did you start the company?
We started Quin about seven years ago. So we've had quite a lot of twists and pivots and turns along the way, and in the last several months, we started to take off and achieve the kind of engagement we're looking to achieve.
And what led you to launch the company?
I don't know how familiar you are with diabetes and the challenges in the space, but 80% of people with diabetes cannot achieve recommended medical targets and are two to three times more likely to have fatigue and anxiety and stress, and depression. And underneath those statistics, as I have become aware over the last seven years, is just a whole host of unmet self-management needs.
Diabetes is a condition managed by the individual when away from their doctor or living their day-to-day life. That's where 99% of care happens. And the needs of that care have gone underserved by the medical community. I learned that because I had a-co founder at Quin - she's now since gone on to do a Ph.D. and is just not working with the business anymore - but she's the one who clued me into the hundreds of decisions a day that people are making to keep themselves alive and well. The decisions about things we take for granted. Something like: "I'm going to eat this food. How much insulin do I need to offset it with?" "Is it safe for me to get my kids at the nursery?" If I go into this client meeting?" "Am I going to get a little bit loopy?" "Do I need to do something like eating some sugar?" Do you know? These essential things don't worry about for those who aren't living with diabetes.
And so, I got clued into this set of challenges and the need for just basic consumer technology to be used in a way that helps to alleviate that load. So, that's what we're doing at Quin: taking data from diabetes devices and phones and using it to build up these complex models, which have a personal behavior and physiology, then using that to provide hyper-personalized education. In other words, ask the question: how does this drug, food, exercise that I'm putting into my body allow me to take care of others. When things go wrong, you have to correct them two hours later. And so there are a lot of ups and downs in this world, which requires guidance, specifically decision-making guidance, which I mentioned. People make 180 decisions a day, so we are using people's past personal experiences to guide them to make decisions at the moment.
And are you trying to change people's behaviors?
Not in the traditional way that people think about changing behavior and diabetes. We're looking to empower people with confidence, knowledge, and better well-being to get better health outcomes. And for us, that means is hyper-personalized education, support, and guidance that provides insights for people based upon their personal information and intrinsically motivates them to do something maybe a little bit differently. And an example might be insulin stacking. All of our users are people who take insulin to manage blood glucose.
Insulin is a long-acting drug, anywhere from five to 24 hours, depending on its and what it's for. And it has acting phases and cycles. It's going to do nothing for a while after you take it, but then it's going to, really, really blow your bookings. And then it's going to start tailing off over time. Many people who have taken insulin for decades struggle with their blood sugar levels. So, they take insulin, want their blood glucose to come down, and don't have the desired effects. So, they take the insulin 30 minutes later, they're still high, so they take more insulin 30 minutes later, and they're still high, so they take more. These are stacking effects. You now have hours of insulin, and, eventually, you're going to crash low, and then you are going to eat sugar to get back up, and then you're going to be in this kind of yo-yo stage.
The kinds of behaviors we might change because you're using insulin would be getting this insight of like: "What? Oh. Stacking." So, if you do want to take this next dose, here's some pretty helpful, pretty relevant information about how much you might take and how it might turn out, based upon your personal past experiences. It's not an app telling you "don't do this," "don't need that," "only do it this way," "check your blood sugar." It's an app that's observing, learning, and using the information about you to empower you and give you confidence through personalized education, support, and guidance. And that's what's helping people get better health outcomes.
Is the goal for greater adherence?
The goal for us is for people to have better well-being right now. Adherence isn't a word that we use. We talk about engagement. Adherence and compliance are medical terms about getting people to do stuff. And, in our world, we talk about engagement. There is loads of research going back decades that say that if people engage with diabetes, they do better, even if it's their doctor just calling up every day and saying, "Hey, how's your diabetes?"
But that's not a sustainable solution. What we're doing is helping people to engage with diabetes on their terms. And through that, they're getting better health outcomes. 96% of our users achieve improvements in well-being and health outcomes. 59% are improving HbA1c concerning time and range; the two critical medical metrics tracked in our space. And 58% are people reporting improvements in their well-being. For us, it's about treating diabetes distress. The medical industry, the clinical treatment model for diabetes, is about chasing glycemic outcomes.
Getting good timing and range to get good HbA1c results. So, people are getting all kinds of tools, training, and whatever else to chase that down. But, as I mentioned upfront, 80% of people do not achieve the recommended HbA1c target. So, that's the kind of number that gets checked. That's a colossal number when you're talking about 500 million people. And so, rather than giving people advice, you train people and teach them to help them chase glycemic outcomes because that has created something called diabetes distress. This term is now the diagnosed, clinically validated emotional response to all the wrong things when diabetes.
When you're treating diabetes, and the hundreds of decisions a day that you're making, all the different things that happen make it very difficult. Diabetes distress leads to diabetes-related depression, which leads to diabetes burnout. And so what Quin does is treat that diabetes distress. It's treating the challenges of the cognitive and psychological load that comes with managing diabetes. And then, through that, our users are getting better health outcomes. We're giving people confidence. We're giving them a sense of: "I got this. I can live life how I want to live it." And we're doing that through education, support, and guidance. And they're achieving better medical results.
I'm guessing that stress exasperates whatever challenges they're facing, right?
Yes. Mental health is health. It's a critical part, particularly in diabetes. And as I said, you're making 180 decisions a day. You are two to three times more likely to have fatigue, anxiety, stress, and depression. It is a very challenging condition to live with day in and day out. That is why we are going down this personalized education, support, and guidance. It's all about empowering people with confidence, knowledge, and better well-being to get better health outcomes.
And better health outcomes. You said something like 80% don't achieve this. Do you move that needle? Or where do you measure your success as a result of the app?
We look at two things: time and range. So, many of our users wear a continuous glucose monitoring device, and we have that signal. Our real-world evidence shows that people achieve 10 to 20% improvement in time and range if they're starting at less than 70%, and that's most people. So, as I mentioned, 80% won't achieve the outcomes. It's a very large segment of the population, which can improve 10 to 20% in time and range. Then we look also at a whole host of mental well-being issues. The major one that we're tracking right now is a diabetes distress scale. We use this validated scale to measure month by month consistently. We can move the needle on the well-being measures, such as the 58% of our users seeing improvements.
Resulting in less acute care?
If you're less distressed, you have the headspace to manage better health outcomes, which means you spend less time out of range. So, if you think there's a target blood glucose range if you don't have diabetes, it just kind of runs along. If you do, and you have to take all sorts of actions to manage it, then acute care happens typically at the extremes of the high and the low range. The more we can help people get closer to that range, through relieving their distress, through relieving their mental health, and the wellness side of this, they achieve better health outcomes. Fewer hospital admissions, less time, and decreased hypo or hyper values, which are the two kinds of extremes in the spectrum, then the less acute care you're going to have.
Therefore, the short answer is "yes," and a long answer is you have a lot of work still to get done. For example, we have a clinical study planned for the early part of next year, with the primary endpoints of time and range. We're also looking at time spent in hypo and hyper, as well as, of course, all of the quality of life factors and psychosocial functioning factors.
And this is a tool that the care providers typically recommend? Or is this something that individuals seek out on their own? How did they become aware of you?
Right now, they find out about us on Twitter, Facebook, Instagram, and Tik Tok, which will; be just the typical ways that you would find out about any kind of consumer app. We find that people find us there, and then they come to the app store, download the app, and start using the app, which is available free. We also have some influencers who write about us and tell the world; that kind of word of mouth approach. We envision distribution through the healthcare system and progress down the business pathway. As I mentioned, we have a clinical study, which will provide the validation we need to distribute through the existing healthcare system. It's just anybody. I mean, doctors see it as clearly as we see it. People are managing their condition. For example, the individual performs 99% of diabetes care away from the doctor.
The doctors we work with see the need for tools that provide education, support, and guidance, a personalized approach to the individual. That's a big part of the reason we've been encouraged to go down this pathway; working with our clinical advisory board. It's the self-management load that we need to address with better solutions. That's a big part of what's driven us to step this up; just to help people use their data and their information. We help them be more confident and more empowered to manage better independently. And obviously, we're doing that through education, support, and guidance that are virtually personalized to the individual.
And I know that apps for diabetes are a pretty crowded space. So how did you manage to differentiate yourself from all the other things in the market? And is it lightened? It's a two-part question. Is it also likely that people will use multiple apps? Or was this a single solution?
Yes. There are 1,000s of apps. People have diabetes. There are also dozens of what's called virtual care platforms for diabetes. And all of these solutions, such as apps on the platforms, are taking the traditional care model in diabetes, which includes getting good glycemic outcomes, good time and range measures, good age frequency, and then putting a digital layer on top of that. They're helping people manage and monitor their blood glucose outcomes.
The difference between Quin and all of those other players is that we are saying, "Yeah, that's very important to get good outcomes. But actually, the way we're going about doing it, the tools we're using to do it is making it harder to get those outcomes." We have now created a world where people are two to three times more likely to have fatigue, anxiety, stress, and depression. We have extreme loads of diabetes distress, and people are achieving those levels.
By making solutions, like we're doing at Quin with personalized education, support, and guidance, we can treat people then and treat diabetes distress to get better diabetes outcomes. That's the fundamental difference between what we're doing at Quin and everyone else in the world. People use multiple apps, but they prefer not to use various apps. So there are a lot of challenges out there about how we, as innovators, can do better to integrate our solutions. So a big part of what we're doing at Quin is integrating. We're working towards this vision by bringing critical consumer health apps as regulated medical devices into our umbrella.
Quin is a medical device. It's built with safety measures and all the concerns many people have. Diabetes is a serious condition people live with, and we're in the decision-making loop around it. But how can we integrate other consumer apps and health apps into the self-management experience in areas relevant to managing blood glucose? That's a big part of our kind of future direction?
Is this for type II diabetes?
Well, right now, it's for people who take insulin, and that's all type Is and some type IIs. Next year, we plan to start working on a product that's more specifically focused on people taking oral medications, not necessarily insulin, but other types of drugs for treating diabetes.
Tell us what it was like raising money for this endeavor. I know that is typically a difficult process, so give us your story.
It has been challenging, as it always is. In the early stage of the business, I think we raised over $5 million in capital. The first chunk of that was friends and family. And then we've had a group of sophisticated, high-net-worth individuals who have now funded us through a few smaller rounds. We also did a crowd round on cedars to provide what we wanted to give our users, the people with diabetes, a chance to invest. We've also got some UK Government grant funding; some Innovate UK funding for quite a big chunk of our R&D work in the earlier days. So we've been very fortunate.
We have been supported by some people who believe in our vision and the new future that we want to create for empowering people, plus going after that diabetes distress challenge, such as empowering people with personalized education, support, and guidance to be able to treat health. So we've got investors who have bought into that approach, bought into the progress we're making, and support the team we have working on it. So we've been well supported by the people close to what we're doing.
And is your product available in the UK market?
We launched in the UK about a year ago. Since then, we've been leading up to our launch; for a couple of years, we were working with hundreds of people with type I diabetes, who were helping create the app with us; allowing us to see what's needed. That's where we've got these deep insights from. It's not about chasing blood glucose outcomes. It's much more about giving people headspace and treating diabetes and distress to better health outcomes. So that's kind of how we discovered this insight. And as we've been live now, in the UK, we continue to see more and more results. It's helped us shape the product to what it is now.
We have very strong engagement rates now. That is something that had not happened in diabetes before. People have struggled because they looked at the problem through the health care system challenge, which struggled to engage the individual. That's really where we're focused. How do we put through hyper-personalized education, support and guidance; get these people to engage in a way that will give them a lift in offloading the cognitive and psychological work that's got to be done to live? Well, with the condition. That's what our core focus has been.
We see that 20% of our users spend 15 days or more a month using our, which is an extraordinarily high engagement rate. In health apps and diabetes apps, it's mega unusually high. So we're very proud of that. That's what's given us the go-ahead to start launching in the US. We've just started our early market entry here. As we speak, I'm actually in New York today, working on our US entry, and we're going to go for a much broader launch and rollout in the early part of next year.
Will you raise more money to do that rollout?
Yes. We're raising capital now, which is part of the reason I'm here in New York. We're raising $10 million for a large chunk of continued R&D work for our type I product rollout in the US, Canada, Australia, and New Zealand, with similar regulatory markets and English speaking.
Did you go to the US because of the capital? Or to help you make the connections for the rollout there? Or because there's a different mindset when it comes to investing? Why US investors at this stage?
Number one, there's just way more capital in the US. So I mean, it's this is a rural area where 20 billion-plus was invested in the first three quarters of the year into digital health. So, where there's just a lot more capital, there's certainly more of an appetite for investment in pre-revenue startups, but in the UK and Europe, it's more challenging talking to European and UK investors. But we're present on both sides of the pond with our work.
Right. Investors tend to be more conservative and risk-averse.
For where we are in our life cycle, and what we're aiming to do, and the amount of capital that we need to do it, the US is just a perfect fit for that; and that doesn't mean that we're not raising funds in the UK or Europe. So we need to look at all the options. And that's what we're doing.
We know that the numbers are not great for supporting female founders. Women get a small percentage of venture capital. What has it been like for you as a female founder to try to pull this off?
Well, I've never been a male founder. But you are aware of this fact. 2.3% of venture capital went to women last year. So, the odds are stacked in the other direction. And so I'm aware of that. I feel that. People want to see those numbers change significantly, both men and women. I have personally felt very supported, by both men and women, in terms of doors opening, making connections and offers, and providing frank feedback, which, quite honestly, some of the most important things you can do for a female or any founder; certainly for me as a female founder, getting straight feedback from people about the proposition, and how people see it, has been handy to me in terms of shaping and thinking about how to position myself, and how to present to whom and how to talk to them about our work.
And how is your approach different in the US market than it would be in the UK market? And are the users other?
We're still in quite a bit of a test and learning research phase. There's still the question of whether the product is a fit? But we believe very much that it is. And then there's the question of the acquisition pathways that have worked for us in the UK. And are they going to work here in the US? I'm talking about particular audiences, messages, creatives, and finding the right combination of those things, to be able to acquire users. So, there's a lot to be done, and we're building it up slowly, learning and understanding. You can blow a ton of money trying to acquire and direct consumers to these platforms. We're at two, three weeks now into our US entry. We're looking to know enough to drive downloads cost-effectively, at scale, and have the retention we need by January. So, we're very confident about that.
Will this ultimately be a reimbursable expense if it gets approved?
We have a strong conviction in a direct-to-consumer business model, wherein people will pay out of pocket for it. We are also doing what we need to unlock the b2b for what we're doing. We can present our product, and the industry and the medical profession can see the value in the unmet needs of self-management and the need for personalized education, support, and guidance. There's a strong conviction in the industry, everyone that I speak to, that says, "yes. That's a novel take on the challenge." The challenge isn't just health outcomes.
The challenge is diabetes distress. And there is a strong interest in our insight and our approach, and early results that we can show with 99 96% of people achieving throughputs, health outcomes, and a better quality of life. So there is a substantial interest to distribute what we have through the channels. The challenge or the unlocking step for that is, of course, a clinical study, which provides the evidence needed to distribute to those pathways and get reimbursement.
And if you look at any chronic condition, there's always a co-morbidity that will have an underlying effect. And typically, as I said, it's going to be around depression or something like that. Because people, when they become depressed, don't take care of themselves the same.
Exactly. Yes. And that has been our insight. We started quickly, really looking at insulin dosing and the question of "how much insulin should I take?" And that's not a question anyone can answer exactly. It's done through trial and error, experimentation, and just a lot of ups and downs and things going wrong and guesswork.
We started there, solving that problem, or pieces of that problem, and we began to realize the challenge is so much more significant due to the lack of access to education about all these things. People maybe get some education when they first get diagnosed, but it's 20 years later now. Do they remember it? Of course not! Or perhaps they don't get any education or get insufficient education. So the essential thing we can do is put education at the right moment, at the right time, for that specific individual on a topic that should be relevant to them at that moment. For example, is working on the stress aspect of diabetes and the distress.
There are so many ups and downs, as you mentioned with depression, that it's so easy to check out because so many things are going wrong all the time. So, treating that education gap, distress, and the stress with depression, is a much bigger piece of the problem that needs to be solved. So, I'm landing on that problem statement, which is what's allowed us to produce just personalized, hyper-personalized educational support and guidance, based upon that individual's personal past experiences; not general medical knowledge, but kind of your data filled in around the edges. So, the one and a half minutes or two minutes of information can help you before making the next decision you're about to make.
And one of the challenges is the condition that people have to manage daily. You can't take two weeks off without impacting your health.
Yes. It's a 24/7condition. It's always there, and it's always with you. But, of course, some days are better than others. But it's an incredible challenge to manage, and anything that we can do to help reduce the load of 180 decisions a day, and quite a lot of them going wrong, just to treat that aspect of the condition. And then people achieve their health outcomes.
You mentioned a bit earlier that there'd been a ton of money going into digital health, into digital therapeutics, which will result in a glut of products in the market. How do you think that will consolidate, especially around the diabetes products. What's your sense of that as the market moves forward?
Yes. Definitely. Particularly in the virtual care world, that will be a consolidation, probably within the next three to five years. And I wouldn't or couldn't begin to pick the winners at this point. But there are dozens of platforms out there that are all roughly aiming to do the same thing, which takes a lot of inefficiency out of the system and maybe improves health outcomes for people with diabetes as well. So that is an area that will be ripe for consolidation at some point.
We're doing something so different by working on self-management, and the unmet needs of the 99% of care, as opposed to the 1% of care, that isn't the hospital kind of clinic setting, the time you spend with your doctor. Therefore, we see an excellent opportunity to be distributed through, or partnered with, in some way, any of the winners in that space, because that self-management challenge is there, regardless of what you do in terms of streamlining and workflows with doctors and coaches, and educators and all of that. Because our product is focused on the unmet self-management needs, really being a part of whatever solution shakes out in the virtual care world, whoever the winners end up being,
Have you had any dialogue with the farmers?
Yes. We have had conversations with the major medical device makers in the space and the farmer. And those could be exciting pathways for us at some point in terms of distribution and reimbursement. So, Quin, alongside insulin pens and glucose monitoring devices, those sorts of things, is effectively a new layer of personalization and effectiveness on top of all the other diabetes technology solutions that are out there. And we can certainly see ourselves playing with any of those.
Yeah, because we see a lot of the farmers being interested in these products, because, at the risk of using the word you don't use, but a greater adherence to their protocols means that there are better outcomes, so, we see that the farmer has a genuine interest in these types of products because people do better overall. So, yeah, it's attributed to your device, but it's also attributed to better medication adherence and things like that.
Where can people learn more about your company if they're interested in learning more?
Well, you can look at our website, which is www.Quintech.io
That'll be shown below.
We're on Instagram, Twitter, Tik Tok, all the places you expect us to be; Facebook. You can come and see there; we have users, lots and lots of people engaged, a very high engagement rate. People tell us how much a game changer the equipment has been for them, how much more competent they're feeling with managing diabetes, and how much it's helped them understand themselves and understand diabetes better and make life better. You'll see that when you go to our social channels and website; you'll see that all over the place. So we're very proud of that.
Well, we very much appreciate your time today. We will write some of those notes in a couple of hours so that people can find you and check out your different channels. We appreciate you talking with us. Enjoy New York. Have you gone to the Rockefeller Center yet to see the tree?
Yes. It was too crowded there the other night. I was just too busy. So we'll go back.
We look forward to great things with you in 2022. It sounds like you got a busy year ahead.
Yes. Indeed. Thanks, Mike.
You're welcome. Thank you. Take care.